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  • PART I ADMINISTRATION OF THE GOVERNMENT
  • TITLE XVII PUBLIC WELFARE
  • CHAPTER 118 AID TO FAMILIES WITH DEPENDENT CHILDREN
  • Section 2B Application form; contents

Section 2B. Every application for assistance made under this chapter shall be in writing on application forms prescribed by the commissioner and shall include but not be limited to the following; the name, age and residence of the applicant; the name, date and place of birth of each dependent; the social security number of the applicant, the spouse and all dependent children over sixteen years of age; a list of any motor vehicle or trailer owned by the applicant or dependent; wages, salaries, pensions, fees, tips, bonuses and all other sources of income of all such persons; said application form shall include a statement not inconsistent with federal regulations giving consent to the department to investigate all facts related to the applicant’s eligibility for assistance.

The application form prescribed in paragraph one shall contain a statement that it is signed by the applicant under the penalties of perjury.